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16 October 2015

Putting power in the hands of patients

Mobile phone apps are among the new technologies helping facilitate better-connected care.

By Becky Slack

Heart failure patient Gordon Hennessy doesn’t go into hospital as often as he used to. These days he monitors his own vital signs using a package of technology, education and support from clinicians at Bristol Community Health.

The health centre has been working in partnership with Philips to deliver an innovative supported self-care project, aimed at building evidence for a large-scale, long-term condition management programme. Sponsored by the West of England Academic Health Science Network and concentrated on the population of one GP practice in Bristol, the project focuses on increasing patients’ confidence in managing their own health needs at home, keeping them independent for longer. It also highlights more complex patients who require intensive monitoring and regular support to prevent their conditions becoming worse. If successful, it will be expanded across Bristol.

“All patients self-care to some extent, and supported self-care is all about enabling them to do that better – giving them the tools and support to help them manage their health and well-being,” says Hanna Eklind, a community matron at Bristol Community Health.

As new technologies come on to the market, more opportunities to manage health better are being created, bringing with them many benefits for an NHS under pressure. No longer does the patient experience have to be fragmented and reliant on appointments that need to be made many days, or even weeks in advance. With the Internet of Caring Things, big data analytics and algorithms, as well as secure cloud-based technologies, it is now possible for care teams to monitor hundreds of different people in different locations at the same time – reducing costs and improving efficiencies – and for individuals to take much more responsibility for their own health.

“By securely connecting patient-gathered information to clinical data and turning this into actionable information, we’re helping promote better self-management,” explains Alan Davies, director of home health care at Philips. “Technology is empowering patients to take control. It gives them a better sense of their own well-being and encourages them to do something about stabilising or managing it.”

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Pilot projects that encourage patients to take a more active role in managing their health have identified big cost savings for health providers. In America, an at-home telehealth programme for patients with multiple chronic conditions, operated by Philips and Banner Health, reduced care costs by 27 per cent; it also reduced acute and long-term costs by 32 per cent over a six-month period. These savings were driven by a reduction in hospitalisation rates of 45 per cent over the same period.

“Telehealth is opening up choices for patients and providers, giving them the freedom to transform how, when and where proactive care is delivered,” said Derek Smith, senior vice-president of Hospital to Home at Philips. “By focusing on those patients who generate the greatest health-care spend, we’re able to help these individuals get better care in the comfort of their own homes, while helping health-care providers achieve the financial reductions they need.”

Prevention better than cure
Of course, the benefits of supported self-care are not restricted to those with acute long-term, pre-diagnosed conditions. They also apply to individuals who can use supported self-care to help slow down the worsening of milder forms of illness and disease. As we know, the best way to optimise our health and well-being is to limit risks and take advantage of prevention interventions. Technology can help facilitate this, be it by encouraging people to increase physical activity, balancing nutrition, tracking vital health indicators before a problem occurs or reminding people to take their medicines.

Technology could, for example, prove to be a useful tool in the battle against the big killers: heart disease, stroke, cancer, respiratory diseases and liver disease – conditions that account for more than 150,000 deaths a year, some 20 per cent of which are believed to be entirely avoidable, according to the Department of Health. Although there can be many reasons why people develop these diseases, lifestyle factors such as smoking, obesity and high levels of alcohol consumption increase the risk.

For example, about a sixth of the total UK population smokes cigarettes, including 22 per cent of adult men, 17 per cent of adult women and roughly 8 per cent of teenagers. Smoking accounts for more than a third of all respiratory deaths, more than a quarter of deaths from cancer and about one-seventh of cardiovascular disease deaths. Overall, about half of regular cigarette smokers will eventually be killed by their addiction.

How can self-care technologies help these people? Surveys show that about two-thirds of current smokers would like to stop smoking. Mobile apps have been developed to help them achieve this. The programme of support on offer includes daily trackers, money saving calculators, motivational pictures and videos, and signposting to other services – all in the palm of the user’s hand.

Similar apps exist to help people lose weight, get fit, track the number of calories or units of alcohol they’ve consumed, or nudge them to move if they’ve been sitting for too long – easily done, when you consider our increasingly sedentary pursuits, be it at a desk, in a car or in front of the television.

Apps such as these are a familiar addition to many smartphones these days. However, there are others that are even more intelligent when it comes to the management of health conditions. There are apps to check for signs of skin damage, apps to allow cancer patients to manage chemotherapy toxicity effectively . . . It is even possible to attach ECG machines to smartphones. Meanwhile, Philips has developed apps to help diabetes and chronic obstructive pulmonary disease (COPD) patients manage their own care in partnership with health professionals, while the company’s eCare Co-ordinator and eCare Companion programmes connect clinicians to patients and enable remote monitoring and intervention.

Quality first
The integrity of the data a tool carries is vital if it is to be useful for both clinician and patient. As an industry leader and global brand that works in partnership with health systems around the world, Philips tests all of its new tools thoroughly, both before they hit the market and throughout their lifespan. However, any app that can be downloaded off the internet needs to be investigated properly to ensure it does what it says it does, otherwise patient safety could be compromised. The NHS is aware of these risks and has launched its own Apps Library that contains only those apps it has reviewed for safety. 

Equally, health-care professionals need to understand which apps and other forms of self-care technologies are able to meet the needs of patients, and which patients should be given access to the technologies in the first place.

“GPs feel accountable for their patients and want to know that they are safe,” says Alan Davies. “So one of the things Philips does with supported self-care is to make sure GPs have access to the information they need.  It’s vital that we make the connection between any data an individual may be tracking and the medical data tracked by professionals.”

A key factor here is ensuring that patients are supported when it comes to using and interacting with these new technologies, Davies says. “I’ve talked to some GPs who are concerned about those patients who, instead of being motivated to manage their health within a set of parameters, become more anxious given this clinical knowledge. These are legitimate concerns but can be addressed.”

For instance, it is possible to use modelling techniques to assess a person’s propensity and capability to use and understand technology and its results, particularly more complex machines, such as blood-pressure cuffs, scales and glucometers. “There’s a proportion of the population for whom it may not be suitable for them to use what’s on offer, but for those who can use it we look to educate them through one of our content partners,” he explains. The British Lung Foundation, for example, provides videos for people with COPD, who are then tested on what they have learned, while non-clinical supplementary health coaches can sometimes be provided to answer questions and provide additional support.

While many patients may be nervous or unsure at first, it is often the case “that, once people are used to the new technology, they don’t want to let it go because it does provide a lot of care and reassurance”, Davies says.

These comments are reflected by Gordon Hennessy’s own experiences. He initially found the technology used to monitor his heart condition “daunting” but soon got used to it.

“I’ve found it very reassuring. My community nurse is at the end of the phone, and my doctor’s at the end of the phone,” Hennessy says. “This scheme gives you confidence. If there’s anything wrong my doctor will pick it up.

“It certainly helps me, and I think it would help other people, too.”

This article is part of a thought-provoking series on living health, brought to you by New Statesman in association with Philips, that looks at how technology, innovation and big data are helping to improve your health and our health-care system.

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